Atlanta — Texas, America’s second-most populous state behind California, saw 13 of its last abortion clinics turn away women on Friday, after a federal appeals court upheld a law that practically guarantees that only a handful of clinics will remain open in the state.

The strictest-of-its-kind Texas law requires abortion providers to build hospital-grade facilities and obtain sometimes impossible-to-get hospital admitting privileges. After signed into law last year by Gov. Rick Perry (R), the law forced most of the 41 clinics operating to close.

Thursday’s ruling wiped out a brief victory this summer for abortion rights proponents, when a lower federal court in Texas ruled that requiring clinics to maintain hospital-grade facilities was too onerous when weighed against what the US Supreme Court has said is a “right” to abortion.

The Texas measure is part of a new wave of laws passed ostensibly on behalf of women’s health that have also made it harder to get an abortion. About 1 million abortions are performed in the United States per year, although that number has been steadily trending downward.

“Bible belt” states in the South and Midwest have led the way in efforts to make abortion a tougher choice for women.

It's noteworthy that voters in some of those same states have balked at more-extreme antiabortion proposals. Mississippi voters, for example, last year refused a referendum that would have given fetuses full rights under the US Constitution, in essence making abortion murder.

At the same time, Mississippi is the state closest to having no abortion services available within its borders at all: The remaining clinic is fighting legally to stay open after passage last year of a law similar to the one in Texas. This summer, a US appeals court stayed that law, allowing the clinic to stay open – for now.

“A state cannot lean on its sovereign neighbors to provide protection of its citizens’ federal constitutional rights,” Judge E. Grady Jolly wrote in that case.

The US circuit court that issued Thursday’s ruling agreed that the Texas law does make abortion more onerous, especially for poor women. But noting that the number of abortions has not swelled at the state’s open clinics that could take an overflow from closed clinics, the court said the law does not create an "undue burden" since the service is still available within the state.

Some women in western Texas and along the Mexico border will have to drive for three hours to get an abortion. But state Attorney General Greg Abbott, who is running for governor, has argued that the seven clinics that will remain open are located in the most populous parts of the state, including Dallas, Houston, Austin, Fort Worth, and San Antonio.

The ruling “is a vindication of the careful deliberation by the Texas Legislature to craft a new law to protect the health and safety of Texas women,” Abbott spokeswoman Lauren Bean told the Associated Press.

Aside from the battle over Mississippi’s lone abortion clinic, the Texas duel over abortion rights is arguably the most visible nationally. State Sen. Wendy Davis (D) is running for governor against Mr. Abbott, in part because of her 13-hour filibuster of the law last year, which brought her into national prominence as a stalwart of abortion rights in the South.